Are you overwhelmed with all the flu information in the news? How do you sort out all of the information? Between the seasonal flu and the Novel H1N1 flu, what do you need to know for yourself, your family and your patients? Where do you find the information? It seems as though we are entering flu season with many unanswered questions.
This year we are coping with two separate flu strains; not only the seasonal variety that changes yearly, but also the Novel H1N1 flu. Seasonal flu vaccinations began in early September and the Novel H1N1 vaccine will be available in the fall. Pregnant women are at the top of the list for recommended recipients of the H1N1 flu vaccines as well as certain healthcare workers including Emergency Medical Providers, however both groups historically are vaccinated at a less than optimal rate. Flu vaccines are not only safe for pregnant women but recommended. Vaccinated expectant mothers protect their babies in their first months of life by passive immunity. Breastfeeding moms continue to pass immunity to their infants via breastmilk. Babies are able to be vaccinated for flu once they reach 6 months of age.
Healthcare facilities will be providing their employees both the seasonal and H1N1 vaccines. Intensive Care staff and Emergency Department staff along with Emergency Medical First Responders will be amongst the first vaccinated in the healthcare setting. The high risk population will be vaccinated with the H1N1 vaccine first; pregnant women, household contacts and caregivers for children < 6 months of age, healthcare and emergency medical services personnel, people ages 6 months to 24 years of age, and persons aged 25 through 64 with health conditions associated with higher risk of medical complications from influenza. There is not expected to be a shortage of H1N1 Vaccine. Healthcare providers administering vaccines that are concerned about liability issues need to be aware that they are covered by the Vaccine Injury Act. The elderly population without health conditions associated with a higher risk of complications are at a lower risk of H1N1 than the younger population. Elderly should receive the seasonal flu vaccine and also become vaccinated with the H1N1 flu vaccine when it becomes available to their population.
The Centers for Disease Control (CDC) are continually reviewing healthcare provider issues to protect themselves and employers may check the CDC website for updates. Much of the information is available through the media, however the CDC website is the best resource for the most current information.
It is suggested that individuals do some advance planning and preparing in their homes and workplaces this flu season. Working at home should be explored and allowed when possible to decrease the unnecessary spread of flu virus. Employers are encouraged not to bog down the healthcare system with the need for notes from healthcare providers and employees are encouraged to stay at home until they are fever-free for at least 24 hours. Flexibility in the employee policies is encouraged as schools and daycare providers enforce strict requirements to return to school following illness. The message not to call their healthcare provider with normal flu symptoms is trying to decrease the unnecessary calls, however, it is important to impart the information of when care becomes urgent. The need for emergency medical care is evident when patients experience a fever not responding to Tylenol, chest/abdominal pain or pressure, difficulty breathing or shortness of breath, sudden dizziness or confusion, severe or persistent vomiting or decreased fetal movement in the pregnant population. Patients will need clear education to ensure that they seek help when necessary.
Caring for pregnant patients with the flu is determinant on the type, however often the type of flu is unknown. The CDC has definitive care described on their website for both seasonal and H1N1 flu. This information is available at www.cdc.gov. Emily Bergmann, RN, CIC, Infection Prevention and Control Coordinator at Advocate Condell Medical Center in Libertyville, Illinois suggests obstetric nurses follow these recommendations to protect themselves and to prevent themselves from spreading flu:
• Be vaccinated
• ALWAYS wear a mask in the presence of anyone with a cough
• Wash hands before and after patient care, also before and after using a mask
Emily also suggests that mother-baby nurses include the following information in their discharge and care instructions for their patients:
• Family members of the new infant living in the household should all be vaccinated for flu if possible
• Anyone with flu symptoms should wear a mask if they must care for the infant
• Keep the infant in a separate room from anyone who has a cough
• ALWAYS wash hands before and after handling the baby
Obstetric nurses have the opportunity daily to teach patients how to cope with this year’s flu season. Nurses and health care workers must be diligent with their care and education to keep this flu season to a minimum. Handouts can be especially helpful for patients to understand vaccination information and vital information patients need to know about the flu. The following links will provide you with up-to-date handouts you may share with your patients. Spread the word, not the flu!
A Tale of Two Flus: A Focus on Seasonal and Novel H1N1 During Pregnancy (Kroger MD)
One of the most recognized gestational diabetes programs in the country is the Sweet Success program. Founded by the California Diabetes and Pregnancy Program of the Maternal and Child Branch of the Department of Health Services, this program has several years of experience and data that prove healthcare and education invested in expectant mothers with gestational diabetes improves the health outcomes of not only herself but of her children. Sweet Success data describes future healthcare savings for improved education and management of the gestational and type II diabetic patient during pregnancy. This care and education will decrease future dollars spent on birth defects, pre-term labor, macrosomia, special care nursery days as well as initiation of type 2 diabetes later in life. Her children will experience less childhood obesity and type 2 diabetes. “Studies have shown that $3.00 to $5.00 are saved for every $1.00 spent on diabetes and pregnancy care” (2). This program may be implemented in your hospital; the program guidelines and membership may be purchased.
If finding the necessary budget dollars to fund Sweet Success is not realistic, measurable improvements can still be made. These ten tips will help you evaluate your current program and create the changes needed to improve the long term outcomes of your patients.
Make Gestational Diabetes Education a team effort. Enlist the help of your diabetic educator, childbirth educator, lactation consultant, healthcare provider/clinic staff, hospital nursing staff and dietitian. Education should flow between the disciplines and each should have an understanding of everyone’s roles. Collaboration will ensure everyone is following the same standards. Use these team members to evaluate your patient prevalence and high risk population.
Set measurable goals. Determine priorities and initial goals and re-evaluate yearly.
Create a basic program that all disciplines are aware of and are knowledgeable about. All members of the team should be aware of content of the education and support the one curriculum. Follow one set of standards; American College of Obstetricians and Gynecologists or American Diabetes Association.
Educate all patient contacts about the program; healthcare providers and their office staff, clinic staff, inpatient nursing staff, dieticians, childbirth educators, lactation consultants, diabetic educators and dieticians. Everyone in contact with the patient should have access to resources and be knowledgable of the process to refer patients for subsequent services such as additional visits with the diabetic educator, social services, lactation consultant or dietician.
Unify the message. Team members need to support “Breast is Best” and creating a healthy family lifestyle. Patients should be empowered with the changes needed during and after pregnancy. They need to embrace ownership of their disease to manage the rest of their lives. This message must come through the education consistently.
Use all your “teachable moments”. Layer the education with other services. Add timely handouts with office/clinic visits. Create group classes. A Lactation consultation can follow an NST visit to facilitate learning how breastfeeding can help prevent or delay type 2 diabetes in the baby. Follow-up phone calls should follow the initial educational consult to answer questions. Dietitians can consult during postpartum hospitalization. These are just a few creative ways to educate the patient.
Repeat the message. Create simple concise handouts repeating key points. The message needs to remain clear to create a healthy lifestyle following the pregnancy. Pregnancy can offer many challenges to provide education with patients distracted by the excitement of giving birth. Pregnancy also can be a time when patients and families are highly motivated to make good choices.
Maximize reimbursement for services. Each program team should research opportunities for reimbursement for services. Be sure to collaborate with your billing/coding/finance experts in your facility.
Measure quality. Re-evaluate your program’s goals and make necessary changes. Be sure to include patient feedback as well as feedback from all involved in your program. Check back with patients at 6 months and 1 year to evaluate their success with lifestyle changes and healthy choices. Your program can make a difference with commitment and teamwork.
Henry, M., Slocum, J., & Kelly, t. (2005). Diabetes and pregnancy resource manual: Tools for success. Fountain Valley, CA: SSEP.
Diabetes Mellitus: Did You Know? Sweet Success California Diabetes and Pregnancy Program Fact Sheet